Monday, October 1, 2012

As a group, higher
functioning students with autism spectrum disorders (ASD) tend to demonstrate
strength in formal language, but a weakness is pragmatic and social skills. As
a result, they often fail to qualify for speech-language services because they
present strong verbal skills and large vocabularies, and score well on formal
language assessments. Nevertheless, significant and severe deficits in the
ability to communicate and interact with others can limit their participation
in mainstream academic settings and community activities. Moreover, pragmatic
deficits tend to become even more obvious and problematic as social and
educational demands increase with age. Assessments to identify pragmatic
language deficits are not as well developed as tests of language fundamentals. Although
there are few standard measures available to assess these skills in higher
functioning children with ASD, the Children’s Communication Checklist (CCC-2)
is a promising third party checklist that can be used in screening and
identification of pragmatic language problems.

The Children’s
Communication Checklist (CCC-2) is a measure designed to assess the
communication skills of children 4 to 16.11 years of age. The purposes of the
CCC-2 are the identification of pragmatic language impairment, screening of
receptive and expressive language skills, and assistance in screening for ASD.
The CCC-2 has shown utility in identifying children who may require further
assessment for an autism spectrum disorder (ASD). Initially developed in the
United Kingdom, the CCC-2 has been adapted for use in the United States
(Bishop, 2006). A Caregiver Response Form is completed by an adult who has
regular contact with the child, usually a parent, teacher, therapist, or other
professional. The CCC-2 consists of 70 items that are divided into 10 scales,
each with 7 items. The first 4 scales focus on specific aspects of language and
communications skills (content and form). The next 4 scales assess the
pragmatic aspects of communication. The last 2 scales measure behaviors that
are usually impaired in children with ASDs. The respondent rates the frequency
of the communication behavior described in each item from 0 (less than once a
week or never) to 3 (several times a day or always). Interpretation is based on
a General Communication Composite (GCC) and the Social Interaction Difference
Index (SIDI). A significantly depressed communicative competence score, coupled
with a score of less than 11 on the SIDI, suggests a profile of ASD and the
need for further evaluation. The CCC-2 reports a sensitivity value of .89 and a
specificity value of .97 for identifying children with autistic symptomatology
and pragmatic social impairment (Bishop, 2006). Previous versions of the CCC-2
have been strongly associated with the ADI-R total score and ICD-10 diagnostic
criteria.

Conclusion

The CCC-2 appears to be a
well-constructed instrument that has both face validity and reliability to achieve
its stated purpose of assisting in identifying children with language and
communication problems, especially in the area of pragmatic communication
skills. In a recent study (Volden & Phillips, 2010), the CCC–2 was found to
be a more sensitive tool than the Test of Pragmatic Language (TOPL) for
identifying pragmatic language impairment in high-functioning speakers with ASD
who have structural language and nonverbal cognitive scores within typical
limits. The CCC-2 also has the advantage of sampling pragmatic skills in the
child’s natural environment. In addition to other more comprehensive
communication and language assessment tools, the CCC-2 should be a welcome and
useful addition as either a screening tool to identify children who are at risk
and need additional assessment, or a supplemental tool to other testing.

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